Increasing AHI despite fewer leaks

[Jay51]

If OA's "cluster" together like yours are doing in this chart, they are most likely positional.  One other thing to try is reducing the height of your pillow.  That might help.  

Raising EPAP pressure is usually the first thing a titration calls for in reducing OA's.  If higher pressure is used and there are still clusters of OA's, then it is most likely positional.

[Aife]

By increasing EPAP pressure, you mean reducing EPR, or even turning it off completely?

If it is positional apneas again, I suspect it's because my cervical collar isn't always fully supporting my chin. I have a weak chin, so it's possible it's kind of slipping through during the night.

[Jay51]

I am sorry if the explanation was confusing.  

When titrating, EPAP is supposed to be raised until OA's stop.  Sometimes, pressure goes to max, but a person still has OA's.  

EPR can be used with any EPAP setting of 7 or greater.  EPR is a great way to try to stop or limit flow limitations.  Keep EPR on full time.  

But, increasing EPR can increase CA's in some people.  You have a few CA's, but hopefully those will stop in time. 

Hopefully, getting your collar working better will stop the OA clusters.   I hope all of this helps.

[Aife]

Hello again,

I thought I'd give you guys an update and see if you think I'm doing as well as I can or if there's anything else I can try.

Yesterday I had a pretty typical night for me relative to this last month, not my best but quite good. What do you think?

[Jay51]

This is the best chart that you have posted so far.  Your CA's have reduced significantly.  You still have 0.10 95th percentile flow limitations.  But if you add in EPR of 1, 2, or 3, it may cause more CA's.  

You can try EPR 1 when you feel like your CA's are about as low as you think that they will get.  By adding EPR, your flow imitations should decrease.  If this doesn't work, you can always go back to these settings.  Also, you may adapt to EPR1 like you have adapted to your apap therapy (your CA's have reduced significantly the more you have used your pap machine).